Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Hospitalsparken 15, 7400 Herning, Denmark; Institute for Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
Department of Anaesthesia and Intensive Care 6021, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
Aust Crit Care. 2023 Nov;36(6):1035-1042. doi: 10.1016/j.aucc.2022.12.008. Epub 2023 Feb 9.
Delirium is common in critically ill patients with detrimental effects in terms of increased morbidity, mortality, costs, and human suffering. Delirium detection and management depends on systematic screening for delirium, which can be challenging to implement in clinical practice.
The aim of this study was to explore how nurses in the intensive care unit perceived the use of Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the Confusion Assessment Method for the Intensive Care Unit-7 (CAM-ICU-7), and Intensive Care Delirium Screening Checklist (ICDSC) for delirium screening of patients in the intensive care unit.
This was a cross-sectional, electronic-based survey of nurses' perceptions of delirium screening with the three different instruments for delirium screening. Nurses were asked to grade their perception of the usability of the three instruments and how well they were perceived to detect delirium and delirium symptom changes on a 1- to 6-point Likert scale. Open questions about perceived advantages and disadvantages of each instrument were analysed using the framework method.
One hundred twenty-seven of 167 invited nurses completed the survey and rated the CAM-ICU-7 as faster and easier than the ICDSC, which was more nuanced and reflected changes in the patient's delirium better. Despite being rated as the fastest, easiest, and most used, the CAM-ICU provided less information and was considered inferior to the CAM-ICU-7 and ICDSC. Using familiar instruments made delirium screening easier, but being able to grade and nuance the delirium assessment was experienced as important for clinical practice.
Both the ICDSC and the CAM-ICU-7 were perceived well suited for detection of delirium and reflected changes in delirium intensity. The CAM-ICU was rated as fast and easy but inferior in its ability to grade and nuance the assessment of delirium. Emphasis on clinical meaningfulness and continued education in delirium screening are necessary for adherence to delirium management guidelines.
谵妄在重症患者中很常见，会导致发病率、死亡率、成本和人类痛苦增加等不良后果。谵妄的检测和管理依赖于对谵妄进行系统筛查，但在临床实践中实施起来具有挑战性。
本研究旨在探讨重症监护病房的护士如何看待使用《重症监护病房意识模糊评估法》（CAM-ICU）、《重症监护病房意识模糊评估法-7 版》（CAM-ICU-7）和《重症监护谵妄筛查检查表》（ICDSC）对重症监护病房患者进行谵妄筛查。
这是一项横断面、基于电子的调查，调查了护士对三种不同谵妄筛查工具进行谵妄筛查的看法。护士被要求对三种仪器的可用性进行评分，并对它们检测谵妄和谵妄症状变化的能力进行 1 到 6 分的李克特量表评分。使用框架方法对关于每种仪器的感知优势和劣势的开放性问题进行分析。
在 167 名受邀护士中，有 127 名完成了调查，他们认为 CAM-ICU-7 比 ICDSC 更快、更容易，ICDSC 则更细致，能更好地反映患者谵妄的变化。尽管 CAM-ICU 被评为最快、最容易和最常用的工具，但它提供的信息较少，被认为不如 CAM-ICU-7 和 ICDSC。使用熟悉的仪器使谵妄筛查更容易，但能够对谵妄评估进行分级和细化被认为对临床实践很重要。
ICDSC 和 CAM-ICU-7 都被认为非常适合检测谵妄，并反映了谵妄强度的变化。CAM-ICU 被评为快速、简单，但在分级和细化评估谵妄方面的能力较差。强调临床意义和对谵妄筛查的持续教育对于遵循谵妄管理指南是必要的。
